Longevity Chiropractic, LLC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

6888 Issued in CO

Legal business name

LONGEVITY CHIROPRACTIC, LLC

Practice address

2447 S Prairie Ave
Pueblo, CO 81005

Phone

(254) 394-0836

NPI assigned

Oct 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Derek Wade Stickler, D.C.NPI 1629326905

Title

Owner/Manager

Phone

(254) 394-0836

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derek Wade Stickler, D.C.

  • Chiropractor
  • Pueblo, CO
  • NPI 1629326905

  CO

  Medicare reassignment Authorized official
• David G Biby, DC CCSP

  • Chiropractor
  • Pueblo, CO
  • NPI 1902901721
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570147200000",
    "number": "1174875298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 SANDPIPER PL",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810069751",
            "telephone_number": "254-394-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2447 S PRAIRIE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "81005",
            "telephone_number": "254-394-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-12",
        "last_updated": "2019-10-04",
        "status": "A",
        "authorized_official_last_name": "STICKLER",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "WADE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "254-394-0836",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NN0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Neurology",
            "state": "CO",
            "license": "6888",
            "primary": false
        },
        {
            "code": "111NP0017X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "CO",
            "license": "6891",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CO",
            "license": "6888",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "CO",
            "license": "6888",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Long
• Patricia D Long
• Robert Long
• Robert M. Long, M.D.
• Longevity Chiropractic
• Lindsey Longfellow, D.O.
• Samuel Longfellow, D.O.
• Taylor Haydee Lopez-Cepero, RDN
• Adrian Lopez
• Carol A Lopez, BSW,CACIII

• All providers in Pueblo, CO
• Rehabilitation Chiropractor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.